Background

In home health care, language barriers are understudied. Language barriers between patients and providers are known to affect a variety of patient outcomes. How a patient's language preference influences hospital readmission risk from home health care has yet to be determined.

Objective

To determine if home care patients’ language preference is associated with their risk for hospital readmission from home health care within 30 days of hospital discharge.

Design

Retrospective cross-sectional study of hospital readmissions from an urban home health care agency's administrative records and the national electronic home health care record for the United States, captured between 2010 and 2015.

Setting

New York City, New York, USA.

Participants

The dataset comprised 90,221 post-hospitalization patients and 6.5 million home health care visits.

Methods

First, a Chi-square test was used to determine if there were significant differences in crude readmission rates based on language group. Inverse probability of treatment weighting was used to adjust for significant differences in known hospital readmission risk factors between to examine all-cause hospital readmission during a home health care stay. The final matched sample included 87,561 patients with a language preference of English, Spanish, Russian, Chinese, or Korean. English-speaking patients were considered the comparison group to the non-English speaking patients. A Marginal Structural Model was applied to estimate the impact of non-English language preference against English language preference on rehospitalization. The results of the marginal structural model were expressed as an odds ratio of likelihood of readmission to the hospital from home health care.

Results

Home health patients with a non-English language preference had a higher hospital readmission risk than English-speaking patients. Crude readmission rate for the limited English proficiency patients was 20.4% (95% CI, 19.9–21.0%) overall compared to 18.5% (95% CI, 18.7–19.2%) for English speakers (p < 0.001). Being a non-English-speaking patient was associated with an odds ratio of 1.011 (95% CI, 1.004–1.018) in increased hospital readmission rates from home health care (p = 0.001). There were also statistically significant differences in readmission rate by language group (p < 0.001), with Korean speakers having the lowest rate and Spanish speakers having the highest, when compared to English speakers.

Conclusions

People with a non-English language preference have a higher readmission rate from home health care. Hospital and home healthcare agencies may need specialized care coordination services to reduce readmission risk for these patients.

Tweetable abstract: A new US-based study finds that home care patients with language barriers are at higher risk for hospital readmission.

中文翻译：

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评估患者语言偏好对家庭医疗保健 30 天再入院风险的影响：回顾性分析

背景

在家庭医疗保健中，语言障碍未被充分研究。众所周知，患者和提供者之间的语言障碍会影响患者的各种结果。患者的语言偏好如何影响家庭医疗保健的再入院风险尚未确定。

客观的

确定家庭护理患者的语言偏好是否与他们在出院后 30 天内从家庭护理再次入院的风险相关。

设计

从 2010 年至 2015 年捕获的城市家庭医疗保健机构的行政记录和美国国家电子家庭医疗保健记录对医院再入院情况的回顾性横断面研究。

环境

纽约市，纽约，美国。

参与者

该数据集包括 90,221 名出院后患者和 650 万次家庭保健就诊。

方法

首先，使用卡方检验来确定基于语言组的粗再入院率是否存在显着差异。治疗加权的逆概率用于调整已知再入院风险因素之间的显着差异，以检查家庭保健期间的全因再入院。最终匹配的样本包括 87,561 名语言偏好为英语、西班牙语、俄语、汉语或韩语的患者。说英语的患者被认为是非英语患者的对照组。应用边际结构模型来估计非英语语言偏好与英语语言偏好对再住院的影响。

结果

与说英语的患者相比，具有非英语偏好的家庭健康患者的再入院风险更高。英语能力有限的患者的粗再入院率为 20.4%（95% CI，19.9-21.0%），而说英语的患者为 18.5%（95% CI，18.7-19.2%）（p  < 0.001）。非英语患者与家庭医疗再入院率增加相关的优势比为 1.011 (95% CI, 1.004–1.018) ( p  = 0.001)。不同语言组的再入院率也存在显着差异（p  < 0.001），与说英语的人相比，说韩语的人最低，说西班牙语的人最高。

结论

具有非英语语言偏好的人从家庭医疗保健中获得更高的再入院率。医院和家庭医疗保健机构可能需要专门的护理协调服务来降低这些患者的再入院风险。

Tweetable 摘要：一项基于美国的新研究发现，有语言障碍的家庭护理患者再次入院的风险更高。